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Table 14. Structured Exercise Programs for PAD
Supervised Exercise Therapy
• Primarily focuses on intermittent walking exercise on a treadmill, interspersed with
rest periods when pain becomes moderate or severe.
• Program takes place in a hospital or outpatient facility and is often placed within a
cardiac rehabilitation program setting ; can be standalone if necessary.
• Program is directly supervised by qualified health care professional(s); generally
clinical exercise physiologists or nurses with exercise training experience.
• Training is performed for a minimum of 30–45 min per 60-min session. Supervised
sessions are performed at least 3 times/wk for a minimum of 12 wk.
• Training involves intermittent bouts of walking to moderate-to-maximum
claudication pain or discomfort, alternating with periods of rest, with incremental
increases as function and symptoms improve. Goal is to progress to 30–45 minutes of
active walking exercise during each session.
• Nontreadmill modalities (eg, stationary bicycle) can used when appropriate and
continually assessed to determine when or if the patient can use a treadmill.
• Supervised exercise therapy is a covered benefit by Medicare and most commercial
insurances.
Structured Community-Based Exercise Program
• Program takes place in the personal setting (eg, home, community, neighborhood) of
the patient rather than in a clinical setting.
• Qualified health care professional(s) prescribe an exercise regimen similar to that of a
supervised program.
• Program is self-directed with the guidance of qualified health care professional(s) and
is generally walking-based.
• Patient counseling ensures understanding of how to begin and maintain the program
and how to progress the difficulty of the walking (by increasing distance or speed).
• Program may incorporate behavioral change techniques, delivered by in-person or
virtual health coaching or the use of activity monitors.
• Program may include periodic supervised exercise sessions to assess progress, reinforce
adherence, and make exercise prescription alterations when appropriate.
Structured exercise programs are planned by qualified health care professional(s) and provide
recommendations for exercise training with a goal of improving functional status over time.
Structured exercise programs for PAD are classified as SET or a structured community-based
exercise program. Structured community-based exercise programs include home-based
programs.
Modified with permission from Gerhard-Herman, et al. Copyright © 2017 American Heart
Association, Inc., and American College of Cardiolog y Foundation.
